Register for VBS

Family Information

Address

Primary Phone

Alternate Phone

Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other

Phone Number

Who can pick the student up other than listed parents?

Student Information

Gender

Birth Date

Age Group

Food Allergies

Details

Medical Concerns

Details

I hereby grant permission for Checotah First Assembly of God to record sounds, images, or video of my child Yes No Will sign a release form if yes.

I have more students to register